Jane R. Coyle, LCSW

 

Specializing in the Treatment of Anxiety 
Directions  and Prep Materials                                                                                              
Directions

My office is located in Vero Beach, Florida, in the
Executive Office Center of the Univest Building just south of the Barber Bridge at 2770 Indian River Boulevard.


For a map and directions, click here.  My office is on the third floor.


Materials for our first session

You may download these at your convenience. For all but two, I need you to print, read, sign, and bring them in to our first session.  

Sometimes parents of an adolescent in treatment are confused about what I am asking with regard to the forms. Let me clarify what I need.  I need each parent to complete a set of these forms with information about you.  It is important that I get a clear picture of the parents to fully understand the adolescent.  This may feel uncomfortable for you, but please know that it is essential for my treatment of your child. Therefore, please complete the forms in the first group below and bring them with you. I will maintain your privacy by not sharing the information you give me on these forms with unless you give me permission in writing. 

If you encounter a problem with downloading the forms, I can: 
  • email them to you or 
  • ask you to pick them up at my office or 
  • you may come a half hour early to complete them.

I will have a copy of our financial agreement ready for you at our first session. 


To print, read, sign, and bring in to me: 
  1. "General Information"
  2. "Adult Patient Information"
  3. "Consent for Treatment"
  4. "Lifestyle A"
  5. "Lifestyle D" (females)
  6. "Lifestyle M" (males)
  7. "Alcohol Use"
  8. "Drug Use"
Adolescents, complete the forms above but instead of the "Adult Patient Information" do this one: 

To read only: 
  1. "Notice of Privacy Practices"
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